Medium-term Outcomes of Balloon Aortic Dilation and Surgical Aortic Valvotomy for Severe or Critical Neonatal Aortic Stenosis
Jeremy Herrmann, MD, Nicholas Zaban, MD, Mark Rodefeld, MD, Mark Turrentine, MD, Ryan Alexy, MD, John Brown, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Objective: Severe neonatal congenital aortic stenosis (AS) typically requires early palliative intervention. Balloon aortic dilation (BAD) and open surgical aortic valvotomy (SAV) are acceptable treatment options. We aimed to compare the contemporary outcomes of these techniques at our institution.
Methods: Patients <60 days old with severe or critical AS who were candidates for biventricular repair who underwent BAD or SAV at our institution were retrospectively reviewed.
Results: Fifty-five patients met inclusion criteria. The table lists patient characteristics. Maximum follow-up was 15 years for BAD and 5 years for SAV. There was no difference in pre- or post-procedure mean gradients between groups (Table). Moderate or greater post-procedure aortic was present in 17.5% of BAD patients and in no SAV patients. Median post-procedure hospital length of stay was 14.2 days for BAD and 19.8 days for SAV (P= 0.52). Freedom-from-reintervention at 1 and 5 years was similar between groups. There was one late mortality in the BAD group.
Conclusions: In patients with AS requiring intervention within the first 60 days of life, BAD and SAV provided similar short-term reductions in valve gradient though BAV was associated with more frequent post-procedure moderate or greater AI. Both groups had similar mid-term freedom-from-reintervention. Longer-term studies are needed to determine whether an initial BAD or SAV approach yields superior results in neonates.
| BAD (N=40) | SAV (N=15) | P value | |
| Mean age at procedure (days) | 20.7 | 14.7 | 0.20 |
| Critical AS present (%) | 32.5 | 46.7 | 0.43 |
| Pre-procedure AV gradient (mean, mmHg) | 47 | 51 | 0.29 |
| Post-procedure AV gradient (mean, mmHg) | 26 | 26 | 0.87 |
| Maximum follow-up (years) | 15 | 5 | |
| 1-year freedom-from-reintervention | 69 | 61 | 0.75 |
| 5-year freedom-from-reintervention | 47 | 17 | 0.13 |
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